A full male hormone panel, not testosterone alone — which is what makes the result actually interpretable.
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Testosterone testing is more easily got wrong than almost any other blood test, and the commonest error has nothing to do with the laboratory. Testosterone follows a daily rhythm, peaking in the early morning and falling substantially through the day. A sample taken at three in the afternoon can read as low in a man whose levels are entirely normal.
This panel measures the full hormonal picture rather than testosterone alone, because a single total testosterone figure rarely answers the question on its own.
Total testosterone — all the testosterone in the blood, most of which is bound to proteins and therefore not available to your tissues.
Sex hormone binding globulin (SHBG) — the protein that binds testosterone and holds it inactive. This is why total testosterone alone misleads: a man with high SHBG can have a normal total testosterone and genuinely low available testosterone. SHBG rises with age, thyroid overactivity and liver disease, and falls with obesity and insulin resistance.
Free androgen index — calculated from those two, and a better reflection of what is actually available to act.
LH and FSH — the pituitary signals. These distinguish where the problem is: high LH with low testosterone points to the testes; low or normal LH with low testosterone points to the pituitary, which is a different diagnosis with different consequences.
Oestradiol, prolactin and progesterone — raised prolactin in particular can suppress testosterone and occasionally indicates a pituitary adenoma, which needs identifying rather than treating around.
Worth saying directly: low testosterone is frequently a consequence rather than a cause. Obesity, poor sleep, sleep apnoea, excess alcohol, chronic stress and opioid medication all suppress it — and addressing those often raises testosterone without any prescription at all. A diagnosis of low testosterone that skips this step tends to become a lifelong treatment that need not have been.
Included: testosterone · sex hormone binding globulin · free androgen index · oestradiol · follicle stimulating hormone · luteinising hormone · progesterone · prolactin.
A focused testosterone monitoring panel is also available where you are already established on treatment and only need levels checked.
1. Consultation. A full history — including sleep, alcohol, weight, stress and medication, because those are the reversible contributors most often skipped.
2. Referral. To a Randox Health clinic. Because timing is critical, we make sure you book a morning slot rather than leaving it to chance.
3. The sample. Between 7am and 10am, when testosterone peaks. An afternoon sample is not interpretable. Fasting is preferred. A low result should always be confirmed on a second morning sample before any diagnosis is made — single low readings are common and frequently not repeated.
4. Results review. A GP interprets the whole panel together, and looks at whether anything reversible is driving the picture before discussing replacement. Where TRT is appropriate, we explain what it involves — including that it suppresses fertility, which is not always mentioned upfront.
The sample must be taken between 7am and 10am, when testosterone peaks. An afternoon sample is not interpretable. Fasting is preferred.
The sample must be taken between 7am and 10am, fasted. Testosterone follows a daily rhythm and falls substantially through the day.
An afternoon sample is not interpretable, and a low afternoon reading is the single commonest reason men are told they are deficient when they are not. If a clinic will test you at 4pm, that tells you something about the clinic.
UK and international guidance requires at least two low morning samples before testosterone deficiency is diagnosed.
Testosterone drops during any acute illness, after poor sleep, during a period of stress, and with significant weight gain. A single reading captures a moment, not a baseline.
Most testosterone is bound to SHBG and biologically unavailable. SHBG rises with age, thyroid overactivity and liver disease, and falls with obesity, insulin resistance and steroid use.
A normal total testosterone with a high SHBG can still mean genuinely low free testosterone — and a low total with a low SHBG may be entirely adequate. Without SHBG, the total figure can mislead in either direction.
If testosterone is low, why? That is the part routinely skipped.
LH and FSH separate a testicular problem from a pituitary one — and a genuinely low testosterone with low LH needs a prolactin check, because a pituitary tumour is a real and treatable cause that gets missed when someone reaches straight for a prescription.
The commonest reversible causes are obesity, untreated sleep apnoea, type 2 diabetes, excess alcohol, opioids and anabolic steroid use — and several of those respond better to treating the cause than to replacing the hormone.
Time of day, recent illness, sleep, stress, alcohol and weight all shift it, sometimes considerably. Testing during or shortly after an illness produces a low result that recovers on its own.
We will not start testosterone replacement on the basis of one afternoon blood test and a symptom questionnaire, which is how a good deal of the private market operates.
Testosterone replacement suppresses fertility, often permanently in practical terms, and it is usually lifelong once established. It deserves a proper diagnosis first.
If you have used anabolic steroids, results are uninterpretable without knowing that. It is worth telling us — there is no judgement in it, and the interpretation is completely different.
NHS GPs test testosterone free where symptoms warrant it — and should also be checking thyroid, iron, HbA1c and considering sleep apnoea, which are more likely causes of the same symptoms.
If you have not had those checked, start there. It is free and it more often finds the answer.
Testosterone replacement is usually lifelong. Once started, natural production shuts down, and stopping means a period of feeling considerably worse than before.
It suppresses fertility — which matters a great deal if you may want children, and which is frequently mentioned only in passing.
And it requires ongoing monitoring: haematocrit, PSA and testosterone levels. The ongoing cost is the real cost, not the initial consultation, and it is worth asking any clinic for the annual figure before starting.
Testosterone peaks in the early morning and falls through the day, so a sample must be taken between 7am and 10am to be interpretable.
An afternoon result is not usable, and a low afternoon reading is the commonest reason men are wrongly told they are deficient.
Not on one test. Guidance requires at least two low morning samples alongside symptoms.
Any recent illness, poor sleep, stress or weight gain lowers it temporarily, and levels frequently normalise on a repeat.
Possibly — which is why SHBG matters. Most testosterone is bound to SHBG and unavailable to the body.
A normal total with a high SHBG can mean genuinely low free testosterone. Without SHBG, the total figure can mislead.
LH, FSH and SHBG at minimum, and prolactin if testosterone is genuinely low with a low LH — a pituitary cause is treatable and is missed when a prescription is written straight away.
Also thyroid, HbA1c, ferritin and a serious conversation about sleep. Those explain the symptoms more often than testosterone does.
Only if testosterone is genuinely the cause, and often it is not.
Sleep apnoea, iron deficiency, thyroid disease, depression and untreated diabetes produce exactly these symptoms — and sleep apnoea both mimics low testosterone and causes it, so treating the apnoea sometimes fixes both.
Yes, often substantially. Fat tissue converts testosterone to oestrogen, so significant weight loss can raise levels meaningfully without any medication.
It is the single most effective intervention for most men with a borderline result, and it is free.
Usually, yes. It suppresses your own production, so stopping means a period of feeling worse than you did to begin with.
It also suppresses fertility, which matters if you may want children. Both points deserve stating before starting rather than after.
Not on a first consultation, and not from a single blood test.
Where deficiency is properly established we can discuss options and refer to endocrinology. What we will not do is start replacement on a questionnaire and one afternoon sample.
Yes, considerably — and it is worth telling us. Anabolic steroid use suppresses natural production, sometimes for a long time afterwards, and the interpretation is entirely different.
There is no judgement in it. Without knowing, the results are simply wrong.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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